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Brooklyn Veterans Administration Medical Center (BVAMC) NY Harbor Health Care System Residents have a required full-time two-month rotation in their PG-1 year of training at the PRIME Clinic, which is a multidisciplinary outpatient clinic within the Department of Medicine. In addition, residents have a required half time four-month rotation at the Veterans Health Care Clinic (VHCC) during their PGY3 year. Residents may return in their fourth year of training (PGY4) for electives half time up to six months. The BVAMC is a federal government run hospital for veterans of the U.S. Armed Forces. It has 158 medical and surgical beds, 30 psychiatric beds and a full range of outpatient services. Psychiatric services include acute inpatient treatment, the VHCC, consultation-liaison service, drug and alcohol service, posttraumatic stress disorder clinic and other facilities. Ninety-percent of the VA patients are male ages 21-90’s with the majority over 45. Approximately 50% of the psychiatric population has affective disorders, 30% anxiety disorders, 10% schizophrenic, 5% adjustment disorders and 5% other psychiatric disorders. In the PRIME clinic residents evaluate 5–20 patients per day with the average generally 8-12 medical outpatients. PGY3 residents provide evaluation and assessment of veteran population of outpatients assigned to VHCC. Residents at VHCC participate in such programs as TORCH (The Outreach and Recovery Center for Homeless), IPCC (Intensive Psychiatric Community Care Program), and the mental health clinic. They also learn about vocational resource opportunities, compensated and work therapies and psychosocial clubhouses available to these patients. Residents assess and treat a wide range of disorders through pharmacotherapy, individual supportive therapy, and group psychotherapy. They also deal with individuals dually diagnosed (majority with drug and concomitant psychiatric disorder) and evaluate them in ongoing treatment and social service support systems. Supervision in PRIME clinic is done by senior residents, and a medical attending and, when necessary, consultants from other subspecialties. In the PG-3 year outpatient clinic rotation, supervision is done on site by a psychiatric attending (Medical Director) as well as a team of social workers and nurses. The BVAMC is located approximately 6 miles from the primary training site. The PGY-1’s spend five days a week full time there and the PGY3’s spend two full days a week at VHCC Outpatient Clinic (approximately 5 miles from primary site). PGY3’s return to the primary site three days a week, two days to see their patients and supervisors in the Ambulatory Clinic at KCHC and one full day at SUNY-Downstate attending seminars (section 4.0 49-63). In addition, they attend a weekly Journal Club at VHCC (59) and attend weekly Ground Rounds at the BVAMC. PGY1’s attend daily conferences in the Department of Medicine at the BVAMC. The clinical experiences in the PRIME clinic are designed to give residents a broad experience in treating medical outpatients with concomitant psychiatric neurological and other disorders and in providing outpatient care in a multidisciplinary primary care setting. Clinical experiences in the VHCC are designed to give residents a broad experience with types of outpatients not generally seen at KCHC, including patients with PTSD, and veterans with mixed affective states and psychosis. Faculty at the VHCC outpatient includes, 1 full-time psychiatric medical director, 1 part-time geriatric senior psychiatrist, 5 full-time social workers, 1 full- time PA, 1 part time internist and 2 full-time nurses. The faculty at the BVAMC consists of the 11 full-time psychiatrists, 4 full-time PA’s, 17 full-time psychiatric social workers, 11 full-time nurses. Residents returning to the VA for their fourth year can choose electives in consultation-liaison psychiatry, PTSD, alcohol and substance abuse division, primary care, geriatric psychiatry or research. Electives are arranged on an individual basis. Project for Psychiatric Outreach to the Homeless (PPOH) Project for Psychiatric Outreach to the Homeless (PPOH) is a required 12-month rotation (3-4 hours per week) occurring in the PGY-3 year. Residents are assigned to community-based agencies that work with mentally ill homeless or formerly homeless people. These sites have been visited and reviewed by PPOH staff and SUNY Downstate community psychiatrists prior to any resident placements to assure for adequate clinical and educational experience and adequate security and staffing availability. PPOH’s clinical staff consists of 1 full-time psychiatrist (medical director) and 1 full-time social worker (clinical coordinator). Agencies where residents are placed have a multidisciplinary team consisting of social workers, nurses, therapists and case managers. Agencies where residents are placed are approximately 3.8 miles from the primary site of training, and PPOH headquarters is approximately 6.7 miles from the primary site of training. The majority of educational activities take place on site as residents become integrated into the community agency they are assigned. Formal group meetings take place at PPOH headquarters bi-monthly. Monthly supervision is available on site by the medical director and the clinical coordinator of PPOH. In addition, bi-weekly supervision is set up with a community psychiatrist at SUNY Downstate and KCHC to monitor individual resident’s progress, and experience in a community setting and any additional issues that may arise. PGY-3 residents are assigned to the following community agencies:
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